骨质疏松与钙磷代谢-肾脏-ppt课件.ppt

反映骨的矿物盐含量 是诊断骨质疏松的金标准 双能X线骨密度测定法 怎么诊断骨质疏松？ 骨密度检测 骨质疏松症的诊断标准 WHO建议标准：BMD、DXA 与健康成人骨峰值比较 T值 正常 BMD -1 SD -1 骨量低下 -2.5SD BMD ? -1 SD -2.5 ? -1 骨质疏松症 BMD? 2.5SD ? -2.5 严重骨质疏松症 骨质疏松症 + 骨折 Osteoclasts Monocytes Pre-osteoblasts Osteoblasts Osteocytes 防治骨质疏松药物 基础 补充剂 抑制骨吸收药物 促进骨形成 药物 其它 药物 钙剂 维生素D 双膦酸盐 降钙素 SERMs 雌激素 PTH 活性维生素D 维生素K 锶盐 中药等 资料可以编辑修改使用 学习愉快！ 课件仅供参考哦， 实际情况要实际分析哈！ 感谢您的观看 * * ，正常成人体内钙总量约为700-1400g；essential component of energy transfer, intracellular signaling and protein function * * Up to 95% occurs in the proximal tubule Filtered phosphate moves from lumen to cells via Na-phosphate cotransporters located in the luminal membrane * * 90%的骨基质是由I型胶原质组成的 ，I型原胶原有N-（氨基）和C-（羧基）延长端 在前胶原转变为胶原纤维质期间，它们被特异的蛋白酶去除，继而形成骨基质。 每合成一个胶原分子，就会有一个分子的PINP产生， 因而PINP(I型原骨胶原-N端前肽)成了I型胶原质沉积的特异性标志物，因此可定义为一个具有真正意义的骨形成标志物。 在I型纤维原细胞构造期间，PINP被释放入细胞内部，最终进入血液。 * 通过血清骨钙素可以了解成骨细胞，新生成的成骨细胞的活动及状态。骨钙素值随年龄的变化及骨更新率的变化而不同。骨更新率越快，骨钙素值越高，反之降低。在原发性骨质疏松中，绝经后骨质疏松症是高转换型的，所以骨钙素明显升高；老年性骨质疏松症是低转换型的，因而骨钙素升高不明显。故可根据骨钙素的变化情况鉴别骨质疏松是高转换型的还是地转换型的；甲旁亢性骨质疏松症中骨钙素升高明显。 * Definition of Osteoporosis The definition of osteoporosis continues to evolve as we gain a better understanding of the underlying changes in bone and the mechanisms for these changes that lead to the disease. At a National Institutes of Health Consensus Development Conference held in 2000, osteoporosis was defined as a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture, and states that bone strength is a reflection of both bone density and bone quality.1 ? These photographs compare the structure of normal versus osteoporotic bone, illustrating the point that osteoporosis is characterized not only by loss of bone mineral density, but is also associated with a decline in bone quality, including architectural abnormalities, trabecular thinning and loss of trabecular connectivity. This microarchitectural deterioration may particularly increase the risk of vertebral fracture, sin